The 3E Study: Economic and Educational Contributions to Emerging Adult Cardiometabolic Health

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Emerging adulthood represents a uniquely sensitive period for studying social determinants of health in the United States (US), as young people begin to establish their own paths towards higher education, careers, and financial independence. College, specifically, is a time of changing socioeconomic position (SEP) that is not often clearly captured in health research, despite strong ties between SEP and health. Over 40% of all young adults aged 18-24 are enrolled as full-time college students in the US, and they increasingly represent the diversity of the country in terms of SEP, race, and ethnicity, particularly colleges classified as Hispanic-Serving Institutions (HSIs). (The 539 HSIs in the US serve over two-thirds of all Latinx, 40% of all Asian, and 22% of all Black college students in the US.) Despite perceptions that emerging adult college students are at the peak of health, over one-third of college students report being overweight or obese, and the incidence of cardiovascular disease outcomes among young adults has been an increasing cause of concern. This risk is exacerbated for low-SEP students, and students of color, especially since the COVID-19 pandemic began. Therefore, emerging adult college students are a priority population to promote cardiovascular health, and reduce health disparities, before the onset of chronic disease. The proposed longitudinal research addresses these important scientific gaps by creating and studying a de novo, longitudinal cohort of 4,000 racially, ethnically, and socioeconomically diverse young adult college students recruited as first-year students from two HSIs in California and followed over three years, including if they leave college. The study will incorporate anthropometric, institutional administrative, smartphone, behavioral, and self-reported data. The specific aims are: (1) To determine the contribution of emerging adults’ economic stressors (e.g.,income, wealth, financial stress, basic needs, residential environment, subjective social status) to cardiometabolic health outcomes (e.g., weight-related measures, blood pressure) over time; (2) To determine the contribution of educational protective factors (e.g., use of social supports, academic supports, basic needs supports) to cardiometabolic health outcomes over time; (3) examine weight-related behaviors (i.e., sleep, physical activity, diet, disordered eating, smoking) as mechanisms of associations between economic stress, educational protective factors, and cardiometabolic health. This large, diverse sample will have sufficient statistical power to examine how racialized and gendered identities may modify associations between economic and educational exposures and cardiometabolic outcomes, which will help increase understanding of the complex interplay between different social determinants of health and help inform potential interventions to reduce health disparities. Identifying risk and protective factors that could affect weight and blood pressure among diverse emerging adult college students can help inform novel interventions and support services to promote cardiometabolic health in a significant portion of the young adult population.